Pressure is mounting on HCA’s management of Mission Health in Asheville from all sides. The hospital responded with a change in leadership this week.
This round of renewed urgency comes from a new Buncombe County lawsuit and unproductive bargaining with the nurses union.
The union indicated earlier in the week that a major announcement was imminent, but their timetable appears to have changed.
In an apparent effort to quell worries about the hospital, HCA brought in a new CEO to lead Mission Health.
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Concerned parties aren’t convinced that’s going to bring the kind of meaningful changes they’ve been seeking.
Leadership change
HCA North Carolina division president Greg Lowe will replace Chad Patrick as CEO of Mission Health, the company announced this week.
Patrick will move to HCA Florida Orange Park, located in a suburb of Jacksonville, Florida. Patrick held this role previously, and “accepted an opportunity to return,” according to HCA spokesperson Nancy Lindell.
Lowe, like Patrick, has been working for HCA in North Carolina since the company’s purchase of Mission Health in 2019.
HCA, a Tennessee-based for-profit hospital chain, is the largest hospital company in the country. The company acquired the Western North Carolina nonprofit Mission Health system in 2019 for $1.5 billion. In addition to the main Mission Hospital in Asheville, the group operates hospitals in Spruce Pine, Marion, Franklin, Cashiers and Brevard, as well as other health care facilities in the region.
“This change (in leadership) will streamline administrative structure to better support Mission Hospital and facilitate more direct communication between leadership, medical staff and colleagues,” Lindell told Carolina Public Press in an email.
“This restructuring will be significant in driving action-oriented responses to feedback and providing direct access to the vast resources and support of HCA Healthcare.”
Lowe, who is currently a superior to Patrick, will remain president of HCA’s North Carolina division in addition to his new responsibilities as CEO of Mission Health. Lowe will be relocating his office to Mission Hospital over the next few weeks.
“I can think of no higher honor than leading Mission Hospital into its next chapter,” Lowe said.
“I look forward to serving alongside each and every one of you inside Mission Hospital, across all Mission Health, and within our community. My commitment is to listen, act and ensure that Mission Health remains a leader in patient outcomes, a preferred employer and the region’s top choice for advanced (health care).”
Some of those served by Mission Health remain dubious about the significance of Lowe’s move to Asheville.
“I don’t know that I’m hopeful for a lot of change,” State Sen. Julie Mayfield, D-Buncombe, told Carolina Public Press. Mayfield has consistently been critical of HCA’s management of the health care facilities in her district.
“Greg Lowe has been in the leadership of HCA in North Carolina from the get go,” Mayfield said.
“People in this community, and certainly myself included, have viewed Greg as a central character in the management of the hospital. He bears equal responsibility for how the hospital has been run.”
The nurses union reacted with similar skepticism: they don’t foresee this leadership change having a large impact on their negotiations with the hospital.
“Regardless of changes in management, nurses at Mission Hospital are hopeful HCA will settle a strong contract quickly for the benefit of nurses, our patients and the entire Asheville community,” Kelly Coward, Asheville nurse and union member, told CPP in an email.
“We’re unfortunately no strangers to staffing changes and turnover because of the staffing crisis at our facility, which is why fighting for safe staffing remains a top priority for us.”
With the union’s strike vote still current, nurses could announce a strike — or indeed the ratification of a new contract — any day now. The Sept. 9 bargaining session appears not to have been as productive as both parties hoped.
Union leaders were teasing an announcement to this effect for this week, but have now said it probably won’t happen so soon.
Lawsuit from Buncombe
Buncombe County filed a lawsuit against Mission Health in August in the Buncombe County State Superior Court. HCA removed the case to federal court in early September, citing a diversity of state citizenship and the existence of a federal question, according to Lillian Govus, Buncombe County communications director.
The complaint argues that the Asheville hospital’s ambulance practices and mismanagement of the emergency department has cost county taxpayers $3 million.
“The dollar amount is small,” Mayfield said. “It’s pocket change for a company like HCA. But I think it shows that this community is tired of picking up slack for HCA.”
Although the county is already a co-plaintiff in a 2022 federal antitrust lawsuit against HCA, it attempted to join Democratic gubernatorial candidate Josh Stein’s December 2023 suit against the hospital. This effort was blocked by the NC Business Court.
Now, the county has filed a lawsuit of its own, but the content of the suit is similar to that of Stein’s.
Three of the lawsuit’s major claims are:
- Due to deliberate understaffing at the emergency room, Mission Health effectively relies on Buncombe County’s emergency medical services to treat ER patients and keep the hospital running. Buncombe County says this is a violation of federal law, which is why the case was moved to federal court.
- Mission Health now requires transfers from other hospitals to be admitted via the emergency room, which the county claims is a tactic to inflate — and at times redundantly double — health care costs.
- Mission Health’s average emergency room wait time increased from 9:41 in 2020 to 17:41 in 2023. Additionally, the time it takes to transfer a patient from the care of EMS to the care of ER personnel increased by 12 minutes.
“We’re tired of paying for services that HCA needs to rightly pay for,” Mayfield said. “HCA is externalizing costs to the public rather than appropriately absorbing it and making it their own expense.”
HCA has until Oct. 11 to respond to the county’s complaint.
“As we have stated many times, we disagree with the claims in this lawsuit and will continue to defend ourselves through the legal process,” Lindell wrote.
Instances of potential noncompliance
Dogwood Health Trust, a foundation created with the sum HCA paid to Mission Health in 2019, and the independent monitor they selected to ensure HCA abides by the terms of its purchase agreement with the hospital, identified three potential areas of noncompliance with the agreement this summer. Stein announced that he agrees with these findings in August.
Dogwood Health Trust has until Oct. 27 to formally notify HCA of these three instances of potential noncompliance.
Dogwood and HCA will then begin talks to determine how HCA can get back into compliance with its agreement. If the parties cannot come to an agreement amongst themselves, the matter will be seen before a court.
“Everyone hopes that the issues can be resolved before going to court,” Affiliated Monitors project manager Gerald Coyne told CPP.
Precedent exists for avoiding a courtroom: in 2020, the previous independent monitor identified two instances of potential noncompliance with the purchase agreement. After discussions with HCA, Dogwood and the monitor determined that HCA’s efforts were sufficient, and the hospital could be considered back in compliance.
Editor’s note: This article’s description of Lowe’s new roles has been updated due to new information that Mission Health provided after this article originally published.
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